RESUMEN
OBJECTIVE: To summarize and evaluate the progress in the current practices of thromboprophylaxis (TP) in Danish surgical departments. DESIGN: Summary of three questionnaire surveys in 1981, 1985 and 1990. SUBJECTS/SETTING: Hospital departments performing general, orthopaedic or gynaecological surgery in Denmark. MAIN OUTCOME MEASURES: Development or routine employment of TP, standard instructions for TP, indications and methods for TP. RESULTS: Replies were obtained from 85%-92%. During the period the overall use TP increased from 89% of the departments in 1981 to 93% in 1985 to 96% in 1990 (p = 0.03). The use of TP according to standard instructions increased from 50% over 54% to 68% (p = 0.001). Heparin is the drug of choice in 95% and graded compression stockings in 70% of the departments. Only 36% of the departments routinely use TP in emergency surgery. CONCLUSIONS: The development in attitudes towards TP in Denmark complies with the scientific evolution. Methods and indications correspond with the recommendation of the literature and international consensus conferences. However, the low rate of TP in emergency surgery is unsatisfactory, and the use of acetylsalicylic acid as postoperative venous thromboprophylaxis should stop. The authors emphasize the introduction of firm standard instruction for TP in all surgical department. A continuous evaluation of the use of TP in Danish surgical department by means of quality assurance studies is recommended.
Asunto(s)
Pautas de la Práctica en Medicina , Embolia Pulmonar/prevención & control , Servicio de Cirugía en Hospital , Tromboflebitis/prevención & control , Dinamarca , Estudios de Evaluación como Asunto , Humanos , Estudios Retrospectivos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
This retrospective study included all patients over a five-year period who underwent the Hartmann's procedure because of a malignant left-sided large bowel obstruction. Twenty-nine patients were treated with this procedure. The cumulative operative mortality was 14%, and the five-year survival was 31%. Intestinal continuity was restored in seven patients (24%). There were no anastomotic leakages. The treatment resulted in a permanent colostomy in 62% of the patients. The Hartmann's procedure can be employed as a treatment of malignant left-sided large bowel obstruction, but will cause a high frequency of permanent colostomy.
Asunto(s)
Neoplasias del Colon/cirugía , Obstrucción Intestinal/cirugía , Enfermedad Aguda , Anciano , Neoplasias del Colon/complicaciones , Neoplasias del Colon/mortalidad , Colostomía , Femenino , Humanos , Obstrucción Intestinal/etiología , Masculino , Métodos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
In a questionnaire survey among surgical hospital departments in Denmark (1990), we assessed the attitudes and practices of use of postoperative thrombosis prophylaxis (TP). Replies were obtained from 92% of departments. Otological and odontological departments seldom used TP. Among departments performing major surgery a total of 88% used TP routinely (general surgery: 91%, orthopedic surgery: 94%, gynecology: 84%). 68% of these departments used TP according to written instructions. Indications for TP, and methods used, are in accordance with the literature, except for the use of TP in emergency surgery (routine in 36% of departments only), or for the continued use of aspirin for TP in 13% of departments.